From the Guidelines
It is not recommended to give Tylenol (acetaminophen) to a patient with AST 92 and ALT 218, as the elevated liver enzymes indicate significant liver impairment, and acetaminophen can cause additional hepatic damage. The patient's elevated liver enzymes, specifically AST 92 and ALT 218, suggest liver impairment, which increases the risk of acetaminophen toxicity 1. Given the potential for worsening liver injury, alternative pain management strategies should be considered, such as non-pharmacological approaches or other medications with less hepatic metabolism 1. In cases of significant liver impairment or severely elevated enzymes, acetaminophen should generally be avoided altogether, as it is metabolized primarily by the liver and can produce a toxic metabolite (NAPQI) that may worsen liver injury 1. Before considering any medication, it's essential to assess the degree of liver dysfunction, consider the cause of elevated enzymes, evaluate other medication use, and consult with a hepatologist or gastroenterologist when appropriate. Some key points to consider when managing patients with elevated liver enzymes include:
- Assessing the degree of liver dysfunction
- Considering the cause of elevated enzymes
- Evaluating other medication use
- Consulting with a hepatologist or gastroenterologist when appropriate
- Exploring alternative pain management strategies with less hepatic metabolism.
From the FDA Drug Label
WARNINGS Liver warning: This product contains acetaminophen. Severe Liver damage may occur if you take Ask a doctor before use if you have liver disease.
The patient has elevated liver enzymes, specifically AST 92 and ALT 218, indicating potential liver disease.
- The FDA drug label warns against taking acetaminophen with liver disease, as it may cause severe liver damage.
- It is recommended to ask a doctor before use if you have liver disease. Given the elevated liver enzymes, it is not safe to give Tylenol (acetaminophen) without consulting a doctor first 2 2.
From the Research
Safety of Giving Tylenol to a Patient with Elevated Liver Enzymes
- The patient has elevated liver enzymes, specifically Aspartate Aminotransferase (AST) of 92 and Alanine Aminotransferase (ALT) of 218.
- According to a study published in the American Journal of Therapeutics in 2005 3, acetaminophen can be used safely in patients with liver disease and is a preferred analgesic/antipyretic because of the absence of platelet impairment, gastrointestinal toxicity, and nephrotoxicity associated with nonsteroidal anti-inflammatory drugs.
- However, another study published in Annals of Internal Medicine in 1977 4 describes three cases of toxic hepatitis associated with the chronic ingestion of excessive doses of acetaminophen, suggesting that liver damage can occur with excessive use.
Considerations for Patients with Elevated Liver Enzymes
- A study published in Current Gastroenterology Reports in 1999 5 notes that persons who regularly consume alcohol or have been fasting may be more susceptible to acetaminophen hepatotoxicity.
- Another study published in Digestive Diseases and Sciences in 1995 6 reports a case of abnormal serum transaminases following therapeutic doses of acetaminophen in a healthy individual without known risk factors.
- A case report published in the American Journal of Therapeutics in 2014 7 describes a patient who experienced moderate liver enzyme elevation after an acute acetaminophen overdose, despite having an undetectable acetaminophen level and normal initial liver enzymes.
Recommendations
- Based on the available evidence, it is generally recommended to use acetaminophen with caution in patients with elevated liver enzymes, as the risk of hepatotoxicity may be increased 3, 5.
- However, the decision to give Tylenol to a patient with AST of 92 and ALT of 218 should be made on a case-by-case basis, taking into account the patient's medical history, the severity of the liver enzyme elevation, and the potential benefits and risks of acetaminophen use 3, 4, 6, 7.